Tripping with the Schoenthalers: Pokhara Regional Hospital

These are latex gloves in the wound room at

Pokhara Regional Hospital,

nicely lined up for re-use after being washed and dried.

On this day, we went to Pokhara Regional Hospital and met Jeny's childhood friend Andu who trained in Russia and is now a young gynecologist, which mostly means she does c-sections (of the 600 deliveries a month at this hospital, about 75% are sections) and hysterectomies for benign disease; nursing “sisters” due all the vaginal deliveries and episiotomy repairs. She doesn't see any cancer patients because at the slightest suspicion of malignancy they send the patient to the regional cancer center near Chitwan. She was in the middle of a 9 am to 2 pm (the next day) on-duty shift and she seemed to competently breeze by case after case after case, including a newborn with its eyelid sealed to its conjunctiva and an unconscious eclamptic woman transferred to the ICU right before we got there. She works over a hundred hours a week most weeks, and still wears little heels to work.

This is the wound room in the hospital.

This is the wound nurse.

In some ways the hospital is like all other hospitals. They have signs about how to prevent swine flu.

And they have crowds of people sitting around, and crowds of people in the hallways looking lost.

In some ways they differ, though.

Sometimes they ask for money up front,

and you have to do your own laundry.

They have to know about Nepali castes for when they fill out birth certificates.

OB is very busy. This was a slow day, as it was one of Nepal's 276 holidays (only slightly exagerating).

This is one delivery room. Vaginal births are almost all performed by "sisters" (nurses). Fathers don't come into the delivery room. (The other woman in the picture below is getting info for the birth certificate.)

This is the nursing sister who helps Andu.

She was incredibly nice, even if I did have to take three pictures to get her to smile. :-)

When babies are born with problems, they are minimal options. This baby was born about three minutes before we walked into the room. He was born with his eyelid sealed to his skin and conjunctiva. Andu was not uncertain about his chances for normal sight in the future.

But most babies are born just fine, and their infant mortality rate is quite low.

And the wards were full of very proud dads.

The wards were full of tons of family, period.

The hospital supplies the medical expertise and necessary IV fluids, and that is it. Medicines, blankets, food – all has to be brought in by the family. Both the antenatal and post-natal patients are in four-to-eight bed rooms, and they get a bed, a cart for possessions, a tiny cradle and sometimes a bench. Tucked in and around are all their piles of stuff. Many women come from very far away (one reason for the high C-section rate) and they come with their husbands, children, food, blankets, and mothers; more than half of the women I saw were sleeping while their moms took care of the newborns. Kids were playing everywhere, and although dads don't go into the delivery rooms, they were proud baby-holders and protecters and were often the ones responsible for keeping the babies in the sunshine as much as possible, which the hospital encourages.

Most families are extremely poor (most women weren't literate). When they leave the hospital, the hospital gives them a box of baby supplies and one thousand rupees.

Probably the most astonishing part about it was that despite the absolute lack of real facilities, in some ways it was the same as any OB ward: first time moms were ecstatic, young dads were beaming, older moms were exhausted and looked like they couldn't bear one more hard thing; young janitors mopped up blood, bored-looking administrators filled out birth certificates, harried nurses pushed their way past doctors chatting in the hallway on their way to get to the med cart. But it was quieter than the average ward: the women didn't shriek while in labor, and the babies barely cried. And when one the baby with the birth defect was born the gynecologist simply said, “The pediatricians need to see that baby,” and that was it: no stat pages, no emergency CT scans, and no thoughts of a lawsuit.

The gynecologist is married to a young psychiatrist. this is his picture above (he's showing his rabies vaccine which he's been taking since he was bit by a dog (at a restaurant!) last week).

He works parttime at this hospital, and has a young private practice. He is one of only 45 psychiatrists in all of Nepal.

At this hospital, he does consults in the emergency room.

He also has a number of regular patients who he sees for everything from anxiety to psychosis. He puts every single one of his patients on medications, and then sees them for med follow-up and occasionally a bit of "counselling."

He also took us on a tour of his methadone clinic. Under the auspices of the UN (their “Office on Drugs and Crime”) he runs one of the three methadone clinics in the country. At Pokhara's hospital, they have a computerized methadone administration center that already serves 65 clients after just one year of existence. Criteria for admission is that they patients have to have been on IV drugs for over three years, they have to be over 18, and they have to have the support of their family, ie, they have to come in with their family at their first visit. Exceptions to the three-year-IV-addict and 18-year-old rule are made if the potential client is HIV+ or pregnant.

The young men (and so far it's only men, but from all social strata) come once a day, show an ID, and a computer automatically states the appropriate dosage and then an attached machine dispenses the appropriate amount into a tiny plastic cup. The patients then have to take the medicine in front of the secretary and a guard and throw the cup into a wastebasket.

It seems so simple, it's incredible to think that every one of those 65 people represents a saved life, not to mention some inevitable drop in crime or lost income (one young man said he had been spending 2000 rupees a day on heroin; this in a country where he probably makes a thousand rupees a month). And the young junkies were so, so sick – microscopically thin and jaundiced and with god knows what kind of infections not to mention the ever-looming risk of HIV. It was really something to see this little cinderblock building as a sanctuary of re-found lives. And so simple – one (very parttime) doctor, one secretary, one guard, one machine, and less than a gallon of methadone a day.

This is the methadone clinic: